CHICAGO (Reuters), Nov 17 – Cancer experts fear new U.S. breast imaging guidelines that recommend against routine screening mammograms for women in their 40s may have their roots in the current drive in Washington to reform healthcare.
Critics of the guidelines, issued on Monday by the U.S. Services Task Force, an independent panel sponsored by the U.S. Agency for Healthcare Quality, say the new guidelines are a step backward and will lead to more cancer deaths.

Here are some of their concerns.

Dr Carol Lee, chairwoman of the American College of Radiology Breast Imaging Commission, said she fears insurers — both private and public — will use them to pare back health costs.

“These new recommendations seem to reflect a conscious decision to ration care,” Lee said in a statement.

She said since the onset of regular mammogram screening in 1990, the death rate from breast cancer, which had been unchanged for the preceding 50 years, has decreased by 30 percent.

Dr Len Lichtenfeld, deputy chief medical officer of the American Cancer Society, said the influential group will not change recommendations for routine mammograms for women starting at age 40.

But he is worried that women will become so confused by the conflicting recommendations they will stop getting mammograms altogether. “Frankly, from our point of view that would be the worst possible outcome,” Lichtenfeld said in a telephone interview.

Lichtenfeld and other doctors are worried that insurance companies and government insurers will seize on the recommendations as a way to control rising health costs.

“What is going to happen is insurers are going to say, ‘The U.S. Preventive Services Task Force doesn’t support screening. We’re not going to pay for it,’” said Dr Daniel Kopans, professor of radiology at Harvard Medical School and a senior radiologist at Massachusetts General Hospital in Boston.

“There were no new data to assess. One has to wonder why these new guidelines are being promulgated at a time when healthcare is under discussion and I am afraid their decision is related to saving money rather than saving lives,” Kopans said.

“The USPSTF recommendations are a step backward and represent a significant harm to women’s health,” Dr W. Phil Evans, president of the Society of Breast Imaging, said in a statement.

“At least 40 percent of the lives saved by mammographic screening are of women aged 40-49,” Evans said. “These recommendations are inconsistent with current science and apparently have been developed in an attempt to reduce costs. Unfortunately, many women may pay for this unsound approach with their lives.”

Panel of radiologists rejects USPSTF mammogram guidelines
By Charlene Laino
AuntMinnie.com contributing writer
December 2, 2009

CHICAGO – A panel of breast cancer screening experts today told a special news briefing at the RSNA annual meeting that the new U.S. Preventive Services Task Force (USPSTF) guidelines recommending against routine annual mammograms are flat-out wrong.
RSNA members who peppered the briefing applauded as the University of Cincinnati’s Dr. Mary Mahoney, vice-chair of the RSNA Public Information Committee, introduced the panel members, saying “These truly are the experts in mammography. It’s unquestionable: Mammography saves lives.”

The panel members were expressing their dissatisfaction with the newly revised guidelines from the USPSTF that recommend against routine mammography screening for average-risk women in their 40s. USPSTF also recommends women ages 50 to 74 have mammograms every two years instead of every year.

Dr. Stephen Feig, from the University of California, Irvine.
“The net effect of the new guidelines is that screening would begin too late and its effects would be too little. We would save money, but lose lives,” said Dr. Stephen Feig, professor of radiology at the University of California, Irvine and president-elect of the American Society of Breast Imaging.

The breast-screening panel said the guidelines would represent a major setback, wiping out decades of progress.

“Deaths from breast cancer have dropped by 30% since 1990 when mammography screening beginning at age 40 became more widespread,” said Dr. Daniel Kopans, professor of radiology at Harvard Medical School.

Kopans said the task force relied on studies with methodology flaws that underestimated the benefits of mammography.

Feig cited several U.S. and international studies that showed the benefits of annual screening beginning at age 40. Among them was a Swedish study showing that annual mammograms reduce breast cancer mortality by 44% among women who are actually screened.

Radiologists said that concerns about the harms of false positives led the Task Force not to recommend screening for younger women.

“You’re going to have some false positives, if you detect cancer early,” when it is most curable, Feig said.

Dr. Daniel Kopans, from Harvard Medical School.
Feig also discounted concerns about radiation exposure. “The risk is negligible compared with the benefits of screening,” he said.

The breast-screening panel said it supports American Cancer Society (ACS) guidelines, which continue to recommend annual routine mammography screening for all healthy women ages 40 and older.

“Current American Cancer Society guidelines have been shown to save lives,” Kopans said. “The Task Force, by its own admission, said women will lose their lives. That doesn’t seem to be much of a choice.”

Dr. W. Phil Evans, of the University of Texas Southwestern Medical Center, and president of the Society of Breast Imaging, said that the ACS, the American College of Obstetricians and Gynecologists, the Mayo Clinic, the American Society of Breast Disease, and the American College of Radiology are all opposed to the USPSTF guidelines. Only two organizations — the National Breast Cancer Coalition and the Dr. Susan Love Research Fund — are in favor of them.

Kopans said he thinks the government panel had “good intentions.” Evans agreed, pointing out that 12 of its 16 members had multiple graduate degrees.

However, there were no radiologists on the panel, he said.

Kopans said he tried to e-mail the USPSTF data from several studies showing that mammograms save lives, but as far as he knows, his e-mail was ignored.

Dr. W. Phil Evans, from the University of Texas Southwestern Medical Center.
Asked if he thought radiologists were biased, Kopans said, “I would argue if there is no conflict of interest, you’re not an expert. But we have true intentions and are saying to look at the data.”

A big worry, the panel agreed, is that the USPSTF’s recommendations will be used in any possible health plan being considered in Congress. That, in turn, would lead insurance companies to stop covering annual breast screening beginning at age 40, it said.

In fact, mammograms are cost-effective, Feig said. He presented data showing that a quality year of life saved with mammography costs $17,000. In contrast, a quality year of life saved with dialysis costs $55,000.

At a House Energy and Commerce Subcommittee on Health hearing in Washington, DC, today, Dr. Diana Petitti, vice chair of the USPSTS, said that while no radiologists were on the Task Force, they were “consulted and reviewed the recommendations and provided input.”

Petitti told the hearing that their message could have been better communicated, and that it wasn’t saying women younger than 50 shouldn’t have mammograms, just that for them, the risks of mammography may outweigh the benefits.

Told about the hearing, Kopans said that the average primary care doctor only sees about two breast cancer patients a year.

“They don’t know much about breast screening. Women have to be smarter than their doctors and save themselves,” he said.

A second congressional hearing on the issue is planned.

By Charlene Laino
AuntMinnie.com contributing writer
December 2, 2009

NEWER IS NOT ALWAYS BETTER

New guidelines and recommendations from the U.S. Preventive Services Task Force state that women would get almost as much benefit out of having mammograms every two years after they turn 50 as having a mammogram once a year starting at age 40. The task force reports that the benefits of early screening for women between 40 and 49 are small. The report concluded that early testing for these women often results in more false positives, more procedures and more anxiety.
As I stated in my blog “Born In The USA” posted on 11/10/2009, national research and statistics show that the death rate from breast cancer has been steadily decreasing in this country for many years now. If less women are dying from breast cancer, I would conclude that current guidelines, suggesting that annual mammograms begin at age 40, are working to the benefit of women. To me, this proves that early detection is the key to surviving breast cancer. As we all know, detecting cancers earlier means that aggressive, life-saving treatments can begin earlier.
Though early detection benefits all women, African American women, in particular, would be significantly harmed by waiting later in life to begin mammograms. Why? Because African American women are more likely to be diagnosed with breast cancer at an younger age and at a more advanced stage. So, it appears that the new guidelines suggested by the U.S. Preventive Services Task Force were not considering this particular group of women.
We must ask ourselves what is the driving force behind these new guidelines? Could this be a first attempt at giving insurance companies a reason discontinue paying for mammograms beginning at age 40. If these new guidelines are widely adopted, it would not be long before our insurance carriers would begin to change mammogram coverage benefits leading to more out-of-pocket expenses for you and for me.
As a breast cancer survivor and a Radiologist, I am urging my family members, friends, colleagues and patients to continue with the current recommendations by the American Cancer Society and begin annual mammograms at age 40 – earlier if recommended by their doctor.
OUT WITH THE OLD AND IN WITH THE NEW
MAY NOT BE BETTER FOR YOU!

YOU ARE LUCKY IF YOU WERE DIAGNOSED IN THE U.S.

Last month in my blog entitled “Are The Advantages of Screenings Mammograms Exaggerated,” posted on 10/23/2009, I discussed the news from the Chief Medical Officer for the American Cancer Society stating that the benefits of screening mammograms were “overstated.” As I stated previously, after reading Mr. Brawley’s statement, I experienced a wide variety of thoughts and emotions. I definitely did not agree with the report, I felt that the wrong message is being sent to women regarding the benefits of screening mammography, and I am disturbed that this information even was reported to the public. Though my response in my previous blog mainly dealt with my feelings on an emotional level, there is hard data and facts to support those feelings.

The truth is, research and statistics support the vital importance of screening mammography. Statistics from the National Bureau of Economic Research show that a woman diagnosed with breast cancer in the US has a 90% chance of surviving it. In Europe, a woman’s chance of survival is below 80% on average. And these statistics represent women overall – insured and non-insured. Isn’t that great!

Now – ask yourself – why would a woman fare better when diagnosed with breast cancer in the US than in other countries? Well, the National Bureau statistics show that the two main reasons are that in the US breast cancer is diagnosed earlier and treated more aggressively. Being diagnosed earlier is therefore a significant benefit of screening mammography. Once the diagnosis is made, aggressive treatment options can begin. This results in fewer women dying from breast cancer. The National Bureau research findings also showed that from 1985 to 2005, death rates from breast cancer have declined faster in the U.S. than anywhere else.

Remember: Early Detection Saves Lives! And there is no overstatement in that!

Have you heard the recent comments made by the chief medical officer for the American Cancer Society, Dr Otis Brawley? In an official statement recently released (mainly regarding breast cancer and prostate cancer) the cancer society stated that the “advantages of screening for some cancers have been overstated,” but also added that “there are advantages, especially in the case of breast, colon and cervical cancers.” This statement though already confusing was made more confusing by additional statements in the report. The society’s chief medical officer, Dr. Otis Brawley, also said that the organization “stands by its screening guidelines” and that “women are encouraged to continue getting mammograms.”
As a breast cancer survivor, I do not believe that the advantages of screening for breast cancer have been overstated. And I believe that the 1 in 8 women diagnosed with breast cancer each year would agree with me.
I will admit that research shows that there is some debate regarding which early cancers should be closely followed and remain untreated, which early cancers should be treated, how they should be treated and the effectiveness of the treatment. But, more importantly, research also shows that cancer deaths in general are decreasing. So my position is that if breast cancer screening can save one life (one woman – sister – mother – wife) then the advantages are not overstated.
What are your thoughts? How do you feel about the recent report?

Thousands of breast cancer survivors take antidepressants to ward off hot flashes caused by tamoxifen a chemical agent that helps prevent the disease from returning. Some breast cancer survivors take antidepressants to improve or combat their symptoms of depression.
Some research is showing that some popular antidepressants may keep the anti-cancer drug from working as well as it should. There is researching supporting and disputing this theory.
Doctors and patients hoped two large studies would resolve the issue, but they were disappointed this weekend because at the annual meeting of the American Society for Clinical Oncology, scientists in the United States and the Netherlands reached opposite conclusions. The researchers in the U.S. showed a higher rate of breast cancer recurrence in patients taking both drugs. Researchers in the Netherlands found that antidepressants did not increase a survivors risk of recurrence.
The antidepressants, known as selective serotonin reuptake inhibitors (SSRI’s), are a class of drugs that includes fluoxetine (best known under the brand name Prozac) and paroxetine (Paxil).
The records showed a two-year breast cancer recurrence rate of 13.9 percent in women taking tamoxifen along with a certain type of inhibiting antidepressant, compared with a 7.5 percent recurrence rate among women taking tamoxifen alone, according to Dr. Ronald E. Albert of Medco Health Solutions in Franklin Lakes, N.J.
In contrast, Dutch investigators reported just the opposite when they looked at the records of 1,962 breast cancer patients who took tamoxifen between 1994 and 2006. They found no evidence that certain inhibitors increased the risk of breast cancer recurrence in women taking tamoxifen.
So as you can see, the jury is still out on this important research. Evenso, it is still very important for breast cancer survivors to keep the lines of communication open with your doctor. Discuss with your doctor the benefits, risks and alternatives to taking these two types of medication in combination.

New Innovations With You In Mind

In these tough economic times, you may be wondering if doctors and researchers will have the funding to continue to look for new imaging tests that will help make a better more accurate diagnosis for Breast Health. Well yes! There is good news for patients regarding up-and-coming breast health tests that could help doctors and clinicians make a better diagnosis for you. This exciting information was revealed in 2008, at the largest annual national radiological meeting held in the United States– the RSNA.

At the 2008 meeting, researchers from the University of Michigan Comprehensive Cancer Center in Ann Arbor presented promising and exciting findings on new techniques to detect breast disease. It is likely that you have heard about Digital Mammography. But, one of the new, up-and-coming breast imaging tests is Digital Breast Tomosynthesis (DBT). Digital Breast Tomosynthesis (DBT ) is a new tool that involves taking a 3 dimensional (3D) picture of the breast tissue. Because of the sharp, 3D pictures of the breasts, I describe DBT as a “high definition” mammogram. HDTV produces sharper, clearer pictures on TV –digital tomosynthesis produces sharper, clearer images on the mammogram.

How does this “high definition” picture benefit you? Well, it will help radiologists do a better job at seeing signs that can separate cancerous from non-cancerous lumps in the breast. As we all know, early detection is the key to beginning life saving treatment as soon as possible. Digital Breast Tomosynthesis (DMT) is still being investigated at this point, but is promising because it has the potential to save millions of lives.

With the importance of having a breast screening comes along two things that stand out in the majority of women’s minds. Why does a mammogram have to feel so uncomfortable and cold?

Everyone can now relax and not stress about this simple exam. Why? Because a Soft Touch Mammogram is now available. A Soft Touch Mammogram uses the MammoPad®. The MammoPad® breast cushion covers the entire x-ray panel leaving no room for the cold panel to reach your skin. It is a foam-like pad that elevates the coldness and a BIG part of the discomfort.

This is the mammogram for the women that want a mammogram with less discomfort. Now there is no excuse for getting that 5 minute exam that can save an entire life.

The MammoPad® was actually invented by a female radiologist, so this is a product made by a woman for a woman. With today’s modern technology women can now experience what we have all been saying we needed for years- a more comfortable mammogram. Why does it have to be uncomfortable…? Now it doesn’t. This breast cushion provides the comfort that we have been searching for. Women have experienced this soft touch mammogram and have been raving about the difference they experience. A mammogram no longer has to be cold and uncomfortable.